Critical analysis
Acupuncture is a unique alternative therapy in which acupoints on the skin are stimulated using various methods with the aim of treating a host of conditions including pain relief. In this paper, I analyze three articles with a special focus on the following components: mechanism of action, therapy, treatment, side effects, contraindications and usefulness in practice.
The articles under review have been authored by Martin et al. (2006), Rebhorn et al. (2012) and Hutchinson et al. (2012). Hutchinson et al. (2012) conducted a systematic review in order to evaluate the effectiveness of acupuncture in the management of chronic non-specific low back pain. On the other hand, Martin et al. (2006) sought to test if acupuncture relieves symptoms of fibromyalgia. The study conducted by Martin et al. (2006) revealed that acupuncture relieves the symptoms of fibromyalgia. Likewise, Hutchinson et al. (2012) study showed that chronic low back pain is relieved using acupuncture. In addition, Rebhorn et al. (2012) conducted a randomized, controlled, double-blind study that sought to gauge the efficacy of acupuncture when used in human pain models. These researchers concluded that, acupuncture, when applied on predefined points, is effective in the management of experimental pain in healthy subjects.
Mechanism of Action
Rebhorn et al. (2012) acknowledge the fact that there is limited data illuminating on the mechanism of action of acupuncture. These researchers point out that acupuncture-led analgesia occurs through the release of endorphins, inhibition of spinal cord processing, facilitation of descending inhibition, and anti-inflammatory action. These researchers do not discuss how acupuncture-led analgesia occurs via the aforementioned mechanisms. In their study, Rebhorn et al. (2012) postulated that acupuncture-led analgesia occurred via capsaicin-induced neurogenic inflammation. They suggest that acupuncture affects humoral inflammation and the associated pain, but not neurogenic inflammation and the number of activated C fibers.
On the other hand, Martin et al. (2006) focus mainly on evaluating whether acupuncture relieves symptoms of fibromyalgia. They provide little information on the mechanism of action of acupuncture, but from their discussion, they point to the neuroanatomical perspective. Martin et al. (2006) note that needling at sham points on the skin produce neuro-modulatory inputs on the central nervous system.
However, the study provided by Hutchinson et al. (2012) points to the Chinese Qi Model. This model indicates that there are twelve meridians in the body where Qi energy flows. Normally, fine needles are used; they are inserted in the skin along the twelve meridians activate the body’s natural healing. In addition, Hutchinson et al. (2012) contend that acupuncture led pain relief occurs following a series of actions that begin with the inhibition of dorsal horn. Consequently, the descending inhibitory pathway is activated, as well as opioids and serotonin.
When the three articles are critically analyzed, Rebhorn et al. (2012) provide a better explanation than the other two sources. Rebhorn et al. (2012) first highlight the proposed mechanism of action, and later narrow down to capsaicin-induced neurogenic inflammation. They suggest that acupuncture affects humoral inflammation and the associated pain, but not neurogenic inflammation and the number of activated C fibers. The mechanism of action of acupuncture-led therapy is still debatable, and there is limited data explaining this phenomenon. Additional evidence-based studies are needed in order to understand these mechanisms fully; of the three articles, Martin et al. (2006) source is less detailed than the other two.
Therapy/Treatment
Needling stimulation was the main treatment technique used by Rebhorn et al. (2012). These researchers employed two human pain models: intradermal capsaicin injection and the cold processor (CP) test. The researchers tested the efficacy of acupuncture-led analgesia in the reduction of pain using the aforementioned tests. There was a notable reduction in pain upon the use of acupuncture therapy. Pain was introduced in healthy subjects using intradermal capsaicin injection. Acupuncture-led analgesia was then applied to elucidate its effectiveness. Rebhorn et al. (2012) concluded that, acupuncture, when applied on predefined points, is effective in the management of experimental pain in healthy subjects.
Likewise, Martin et al. (2006) used thin needles to apply stimulation at various points on the body of all participants. They used bilateral points at the heart, liver, large intestines, stomach and pericardium. In addition, they used axial paramedian points along the bladder at the cervical spine in the first phase of the treatment, and at the lumbar spine in the last phase of the treatment. During this treatment, each acupuncture point was wiped with alcohol and masked with an adhesive bandage. In the next step, a needle was inserted through the bandage to the acupuncture point; electrical stimulation was applied at 2 Hz or 10 Hz.
In addition, Hutchinson et al. (2012) provided data from various literatures highlighting how acupuncture treatment is administered. Different groups were treated using needle insertion at different acupuncture points, general exercises, injections, massage, and physiotherapy. The studies conducted by Martin et al. (2006), Rebhorn et al. (2012) and Hutchinson et al. (2012) had employed the needling technique as the major form of acupuncture treatment. However, Hutchinson eta al. (2012) used other treatment modalities including general exercises, injections, massage, and physiotherapy.
Adverse Effects
In a study conducted by Martin et al. (2006), these researchers employed the needling technique during the provision of acupuncture therapy. These researchers noted that most of the participants enjoyed during the provision of the therapy, but some reported tiredness. Others had mild soreness and bruising. A few of them experienced vasovagal symptoms.
However, the study conducted by Hutchinson et al. (2012) did not highlight the side effects of acupuncture therapy. These researchers focused mainly on the effectiveness of acupuncture in the management of chronic non-specific low back pain. They did discuss adverse effects associated with acupuncture therapy. Likewise, Rebhorn et al. (2012) have not discussed the adverse effects associated with acupuncture. They focus mainly on testing the efficacy of acupuncture. All the three studies do not highlight the contraindications of acupuncture.
Martin et al.’s (2006) took the form of a randomized-controlled trial. There were two groups; one group received acupuncture treatment, and the other own did not. Both groups were suffering from fibromyalgia. This study employed a sample of fifty participants, and it was conducted in seven months. On a positive note, the findings of this study are evidence-based; both groups had the same condition, but those who received acupuncture had a reduction in their fibromyalgia symptoms. However, this study had various limitations. The sample size was small; in fact, the sample size was dominantly white and was dominated by females. These factors could have affected the study’s findings. On the other hand, the Hutchinson et al. (2012) study was limited to only seven sources that are ten years old. The researchers reviewed seven previous studies only; this limited the scope of their findings. In addition, they had no control over primary findings, and as such, the biases inherent in the primary studies were carried forward. Likewise, Rebhorn et al.’s study (2006) was also in the form of controlled and double-blinded, and was based on primary data. However, the sample size was small (50), and this might have affected the study’s findings.
Usefulness in Practice
The three articles that have been reviewed provide essential data that can be employed in practice. First, the study conducted by Rebhorn et al. (2013) highlights the possible mechanisms of action of acupuncture therapy when it is used as analgesia. According to Rebhorn et al. (2012), acupuncture-led anesthesia occurs via the release of endorphins, inhibition of spinal cord processing, facilitation of descending inhibition, and anti-inflammatory action. Data provided by Rebhorn et al. (2012) illuminates potential mechanisms of action of acupuncture therapy, and advances the understanding of this phenomenon. Alternative therapists can now select appropriate acupuncture modalities by focusing on the mechanism of action.
On the other hand, Martin et al. (2006) sought to test if acupuncture relieves symptoms of fibromyalgia. In their study, they highlighted that acupuncture relieved symptoms of fibromyalgia. Symptomatic improvement from pain, anxiety and fatigue was evident. In line with this, findings illuminated by Martin et al. (2006) boost an understanding of the benefits of acupuncture in pain management. In other words, alternative therapists can now use acupuncture as an analgesic in patients with fibromyalgia. This study provides evidence-based data that boost the understanding of the benefits of acupuncture-led anesthesia.
Furthermore, Hutchinson et al. (2012) conducted a systematic review in order to evaluate the effectiveness of acupuncture in the management of chronic non-specific low back pain. These researchers provide evidence that supports the hypothesis that acupuncture is beneficial in the management of back pain. Therefore, alternative therapy can now use it with confidence. In most cases, acupuncture is employed as a supportive therapy. The findings provided by Hutchinson et al. (2012) second the hypothesis that acupuncture works, and can be used as an additional form of pain management therapy.
Conclusion
In conclusion, although the study’s findings are remarkable to alleviating pain, however, considering the enormity and variance in different types of pain, acupuncture analgesia in combination to pharmacological therapy, might be helpful in alleviating pain among individuals with chronic back pain and fibromyalgia. Additionally, this review has highlighted various possible mechanisms of action of acupuncture-led analgesia. Acupuncture-led anesthesia occurs via the release of endorphins, inhibition of spinal cord processing, facilitation of descending inhibition, and anti-inflammatory action.
In addition, it has been proposed that autonomic nervous system and hypothalamus-pituitary-adrenal axis are also involved in acupuncture-led analgesia. The Qi Chinese model has been also reviewed. This model indicates that there are twelve meridians in the body where Qi energy flows. In line with this, fine needles are employed; they are inserted in the skin along the twelve meridians activate the body’s natural healing. Furthermore, these findings are essential for the nursing practice. They not only highlight the benefits of acupuncture, but also illuminate the possible mechanism of action. Therefore, these findings will help clinicians and nurses to be better informed as they seek to employ acupuncture in the management of their patients.
References
Hutchinson, P. et al. (2012). The effectiveness of acupuncture in treating chronic non-specific low back pain: a systematic review of the literature. The Journal of Orthopedic Surgery Research, 7(36), 1-10. Retrieved from http://www.josr-online.com/content/7/1/36#sec1
Martin, D. et al. (2006). Improvement in Fibromyalgia Symptoms with Acupuncture: Results of a Randomized Controlled Trial, Mayo Clinic Proceedings, 81(6), 749-757.
Rebhorn, C. et al. (2012). The Efficacy of Acupuncture in Human Pain: A Randomized, Controlled, Double-Blinded Study. Pain, 153, 1852-1862.
